Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2012.09.006
Brazilian Journal of Anesthesiology
Clinical Information

Ultrasound-guided facet block to low back pain: a case report

Bloqueio facetário guiado por ultrassom para lombalgia: relato de caso

Ana Ellen Q. Santiago; Plinio C. Leal; Elmiro Helio M. Bezerra; Ana Laura A. Giraldes; Leonardo C. Ferraro; Andre H. Rezende; Rioko Kimiko Sakata

http://dx.doi.org/10.1016/j.bjane.2012.09.006 Braz J Anesthesiol, vol.64, n4, p.278-280, 2014
PDF English
PDF Português
Downloads: 0
Views: 672

Abstract

BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study.

Keywords

Facet block, Low back pain, Ultrasound

Resumo

JUSTIFICATIVA: a osteoartrose facetária é causa frequente de dor lombar. O diagnóstico é clínico e pode ser confirmado por imagem. O tratamento da dor e a confirmação do diagnóstico são feitos pela injeção intra-articular de corticosteroide e anestésico local, por causa da melhoria clínica. A monitoração direta do procedimento pode ser feita por fluoroscopia, técnica clássica, ou guiada por ultrassom. RELATO DE CASO: paciente do sexo feminino, 88 anos, 1,68 m e 72 kg, com osteoartrose facetária em L2-L3, L3-L4 e L4-L5 havia dois anos. No exame físico, dor à lateralização e à extensão da coluna. Optou-se pelo bloqueio da articulação facetária guiado por ultrassom. Foi feito escaneamento longitudinal na linha média da coluna vertebral e identificado o espaço articular desejado em L3-L4. Uma agulha 25G foi introduzida na pele pela técnica fora de plano ecográfico. Foi administrado 1 mL de contraste, confirmado com fluoroscopia. Após aspiração do contraste, foi injetado 1 mL de solução contendo cloridrato de bupivacaína 0,25% e 10 mg de acetato de metilprednisolona. Foram feitas injeções nos espaços L3-L4, L2-L3 e L1-L2 à direita. CONCLUSÕES: a visualização da articulação facetária pelo ultrassom determina mínimo risco e redução da radiação e é indicada para grande parte da população. Ainda assim a fluoroscopia e a tomografia computadorizada permanecem como monitoração indicada para pacientes com características específicas, como obesidade, doenças degenerativas intensas e malformações anatômicas, nas quais o ultrassom ainda necessita de mais estudos.

Palavras-chave

Bloqueio facetário, Lombalgia, Ultrassom

References

Grau T, Leipold RW, Horter J. The lumbar epidural space in pregnancy: visualization by ultra sonography. Br J Anaesth.. ;86:804-798.

Arzola C, Davies S, Rofael A. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg.. ;104:1192-1188.

Lee Y, Tanaka M, Carvalho JC. Sonoanatomy of the lumbar spine in patients with previous unintentional dural punc- tures during labor epidurals. Reg Anesth Pain Med.. ;33:270-266.

Luyet C, Eichenberger U, Greif R. Ultrasound-guided paraverte- bral puncture and placement of catheters in human cadavers: an imaging study. Br J Anaesth.. ;102:534-539.

Gofeld M. Ultrasound-guided zygapophysial nerve and joint injection. Tech Reg Anesth Pain Manag.. ;3:150-153.

Gofeld M, Bhatia A, Abbas S. Development and validation of anew technique for ultrasound-guided stellate ganglion block. Reg Anesth Pain Med.. ;34:479-475.

Gul J, Bum SK, Kyung-Bae S. The optimal volume of 0.2% ropiva- caine required for an ultrasound-guided stellate ganglion block. Korean J Anesthesiol.. ;60:184-179.

Lin CS, Cheng JK, Hsu YW. Ultrasound-guided ganglion impar block: a technical report. Pain Med.. ;11:390-394.

Helayel PE, da Concei¸cão DB, Pavei P. Ultrasound-guided obtu- rator nerve block: a preliminary report of a case series. Reg Anesth Pain Med.. ;32:226-221.

Finlayson RJ, Grupta G, Alhujairi M. Cervical medial branch block: a novel technique using ultrasound guidance. Reg Anesth Pain Med.. ;37:223-219.

Shim JK, Moon JC, Yoon KB. Ultrasound-guided lumbar medial- branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med.. ;31:451-454.

Ghormley R. Low back pain with special reference to the artic- ular facet, with presentation of an operative procedure. JAMA.. ;101:1777-1773.

Bogduk N. On diagnostic blocks for lumbar zygapophysial joint pain. Med Rep.. ;2:1-3.

Greher M, Kirchmair L, Enna B. Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by com- puted tomography. Anesthesiology.. ;101:1195-1200.

Galiano K, Obwegeser AA, Bodner G. Ultrasound real-time imaging for periradicular injections in the lumbar spine: a sonoanatomic study of a new technique. J Ultrasound Med.. ;24:33-38.

Greher M, Scharbert G, Kamolz LP. Ultrasound guided lumbar facet nerve block: a sonoanatomic study of a new methodologic approach. Anesthesiology.. ;100:1248-1242.

McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common exten- sor tendinosis in the elbow. J Ultrasound Med.. ;25:1289-1281.

5dcd9af70e8825b259bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections